NFL doesn’t have independent neurologists on sidelines during games

Posted by Mike Florio on October 19, 2011, 6:00 PM EST

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Though Eagles and Lions fans understandably disagree, something stinks about the ability of quarterback Mike Vick and running back Jahvid Best to re-enter their respective games on Sunday after suffering possible concussions. If, as the “WHEN IN DOUBT, LEAVE THEM OUT” memo sent by the league to all teams before the season states, players should be removed from games if there is “any suspicion” they have suffered concussions, Vick and Best should have been shut down.

The problem arises from the absence of independent neurologists at games. “The team medical staff examines players during games,” NFL spokesman Greg Aiello told PFT via email. “The team neurologist is not required to attend games.”

The league relies on independent neurologists when determining whether a player who has been diagnosed with a concussion will be cleared to play. The thinking is that independent neurologists won’t be influenced by the inherent tension that a team physician experiences when caught between the interests of their patients and the interests of the teams that employ them. It’s a coveted assignment for doctors, whose practices realize a significant boost when they become hired by an NFL team. Most doctors don’t want to jeopardize that job by keeping football players from playing football.

It’s arguably more important to have truly independent neurologists available during games, when players possibly can get back on the field despite suffering a possible concussion.

Specifically, independent neurologists should have the power to hold players out of a game until it is determined, by the independent neurologist, that any player with a possible concussion has neither a concussion nor “concussion-like symptoms.” The process could be aided by the presence of a safety official in the replay booth, whose duties would include monitoring the live action, replays, and anecdotal evidence from the sidelines for the purposes of flagging players who must be held out until cleared to return by an independent neurologist assigned to each team.

It’s a relatively simple fix that the NFL and its players should welcome, if the league is truly serious about dealing with the dangers of concussions. During games, doctors wearing polo shirts bearing team logos will be hesitant, when in doubt, to hold players out, especially when the players and the coaches want to get the players back on the field. The NFL needs to have someone with true independence involved in the process of determining which players should be keep on the sidelines due to concussions (or other potentially serious injuries, like punctured lungs or fractured eye sockets) at a time when the heat of the battle will compel players and coaches to take potentially unnecessary risks — and to have a dim view of any team physicians who try to stand in the way.

If Eagles doctors had deemed Vick a “no go” during Sunday’s game with the Redskins and if the Eagles had lost the game without Vick at quarterback and if it later was determined that Vick didn’t have a concussion, the Eagles doctors who contributed to the slide to 1-5 possibly wouldn’t have been Eagles doctors for much longer. Until that environment changes, with the game-day judgment of team doctors trumped by the discretion of independent physicians, a potentially dangerous loophole will continue to exist.

I agree there needs to be outside parties involved with medical assesments. I know if i was in the players position i would go in if i had the ability too b/c my job depends on me being out there. (see jason campbell, he couldn’t go back in and now they have carson palmer)

“If Eagles doctors had deemed Vick a “no go” during Sunday’s game with the Redskins and if the Eagles had lost the game without Vick at quarterback and if it later was determined that Vick didn’t have a concussion, the Eagles doctors who contributed to the slide to 1-5 possibly wouldn’t have been Eagles doctors for much longer.”

I disagree. I think those very team doctors who were fired fro that would have a very legitimate lawsuit against the Eagles for their firing. Further, these very doctors may have very legitimate laawsuits facing them from players they deemded “ok to play” but in fact were indeed concussed.

I am not saying that they are not biased towards their own team. I am just saying that I think you are being a little over-the-top with doctors not doing their jobs.

Mike, you are somehow missing the significant difference between the Vick and Best situations.

Vick did NOT have a concussion. Best had a concussion. I am not sure why this is so challenging to understand.

There was no suspicion that Vick had suffered a concussion. He was grabbed by an opposing player who later admitted he was trying to get the QB out of the game.

There is another side to the “When in doubt, leave them out” guideline. Sometimes a player is mistakenly held out of a game with disastrous consequences. Vick was held out of the week 2 game in Atlanta after suffering a hit as a precaution. He never suffered a concussion and tried to return to the game. Had he returned, the Eagles likely would have prevailed (they were leading at the time), and the entire season may have turned out very different.

Instead, one of the Eagles’ trainers used the “C” word too loosely, Vick was withheld from returning, and both he and the team suffered terribly as a result.

It would make sense to have a qualified doctor or neurologist available to perform a diagnosis, and it should be done consistently and fairly for all teams.

Vick was getting held up by his own lineman way before Fletcher grabbed him. Like Billick said he looked like a punch drunk boxer when he tried getting up. Apparently a Vince Young pass is the same thing as smelling salt for a concussion.

drbob117 says:Oct 19, 2011 6:28 PM

I can just see a coach like Bill Belichick now scheming to use a rule like that to his advantage. Can’t you see that if you did what you want to do that every team could purposely sideline the other team’s QB in the first few minutes of the game with no consequence except a single 15 yard penalty?

bostontim says:Oct 19, 2011 6:31 PM

The problem with having independent neurologists on the sideline is that they have been trained by the lawyers and the malpractice underwriters. They will always have liability on their mind and they will never say “get back in there”. I don’t want anyone to take a lot of risk here, but this would KILL any from of discretion.

Cheers, BostonTim

sophiethegreatdane says:Oct 19, 2011 6:32 PM

Easy fix: the league hires the neurologists, one for each game per city. They are not employed by the teams therefore no conflict with the team and player decisions. Furthermore, the league would only need one per game, not one per team. Minimal travel would be required as the neurologist would handle the eight or so games played in that stadium. Minimizing travel with the team would limit exposure to any coach or player trying to sway the doc’s opinion.

Each team pitches in to help with the cost, which they are already paying for now.

The doctor has the power to bench players based on his diagnosis. Problem solved.

jackfnburton says:Oct 19, 2011 6:38 PM

That’s too bad. One of them could probably figure out what’s wrong with Rex Ryan.

What doctor with half a brain would s subject himself to such potential liability?

drevilstolemymojito says:Oct 19, 2011 6:42 PM

Independent neurologists can be gamed by NFL teams and owners in quite a number of ways. I’ve seen it happen. The authority of an physician to absolutely prohibit (under threat of some penalty) a person from engaging in an activity also goes far beyond the bounds of normal physician ethics and conduct. What you are trying to describe are the actions and authority of a judge, not a physician. Your contention that neurologists should have the authority to hold players out of games also doesn’t even begin to address the huge civil liability situation that it creates for the physician.

There are (semi) objective measures that can be used to assess the severity of a concussion, such as the ImPACT cognitive test and strain gauges and accelerometers that can be installed in helmets. However, there is much player resistance to the helmets with such sensors, and the the ImPACT test requires a baseline test on which players can willfully underachieve.

Even if I ignore that Vick and Best are two completely different scenarios, or that Vick was in fact very mildly concussed against ATL and the doctors DID take him out and are STILL employed even though the Eagles LOST, what I can’t ignore is your misguided statement against team medical staff.

These are PROFESSIONALS. They would NEVER knowingly endanger a player’s life in order to win a game, because doing so would not only lose them their job, it would lose them their career.

You guys deleted my last comment and probably will delete this one as well, but I stand by my principles and think you need to seriously reconsider your perspective.

The NFL needs to provide medical “officials” to each game just like the do referees. Each team can have it’s own medical staff, but the league medical staff should have final say on major injuries, including concussions. Ideally the NFL would run all the medical staff, but I don’t see that happening. Just 40ish medical staff (2 per game at 16 games with 8 replacement staff) would be plenty. Teams will go out of their way to hide injuries, just like they go out of their way to tape hand signals, or line up on opposing sidelines to “scare” gunners on kickoffs. If you leave room for cheating, it’s going to happen in a business that thrives on winning.

drbob117 says:Oct 19, 2011 7:28 PM

I’m always amazed at how lawyers always feel that physicians can be easily ethically compromised, but they don’t believe that about anyone in their own profession.

rezen73 says:Oct 19, 2011 7:28 PM

Couple of thoughts here:

* Football is a violent sport. If it weren’t, it wouldn’t be as popular as it is.

* Look, let’s be honest here. Players know what they are signing up for. Just like Pat Tillman knew what he was sighing up for when he left the Cardinals to protect our freedoms with the ultimate sacrifice. Let’s not sugarcoat the game any more than it is already. Players know the risks involved – that’s WHY they get paid MILLIONS of dollars. They risk their bodies for the big payday.

* If the NFL is given the power to remove players from games strictly based on purely subjective observation (e.g. an “NFL” doctor “observes” that a player “appears” to have “concussion-like symptoms”), then I’ll stop watching games. I have no interest in watching the NFL become the NBA. I mean, it’s bad enough when the NFL can’t even enforce the Calvin Johnson rule consistently and coaches challenge calls on the off chance that the ref will incorrectly apply the CJ rule! NFL medical staff? Please. The mob will be all over that, even worse than Tim Donaghy.

* This whole “player safety” thing is a sham. If the NFL truly wanted players to be safe, then players would be wearing flags around their waists. Getting bent out of shape because players get hurt is kind of like getting mad because it was cold when you went to Antarctica, or mad at the Sahara because it was hot in the summer. It’s the nature of the beast, and if you don’t like it, tough. Get over it. Don’t get me wrong – I do have sympathy for players that get hurt – but again, that’s their JOB.

omega49 says:Oct 19, 2011 7:38 PM

Since PFT is so concerned about about players getting concussions perhaps they should pay for truly independant neurologists. Seriously, don’t know why PFT is tryng to keep this story alive week 6 is done concussed or not the Lions and the Redskins lost.

bearsrulepackdrool says:Oct 19, 2011 7:39 PM

This is some mess. You can’t keep babying grown men.

Yes, have a seminar at the beginning of the year and tell people about the dangers of concussions.

Then when they have a concussion, let the team doctor tell them and inform them of the risks. If they want to go in the game, FINE, let them go in and TAKE that chance. They want to ruin their lives they can go right ahead. Don’t hold them back, they’re grown!

Grown men make decisions that effect the rest of their lives on their own. Babies let other people make the decisions for them. You treat grown men like babies you are going to have problems.

FOR PEOPLE WHO SAY VICK DIDN’T HAVE A CONCUSSION….WATCH THE TAPE.
VICK TWITCHES RIGHT AFTER THE HIT AS HE IS LAYING ON THE GROUND, STIFF, LIKE A CORPSE. More specifically, watch the tape again and you will notice his leg starts to twitch, very noticeably. Besides the weird leg twitching the guy was not moving on the ground and was seen having to be helped up and held up.

NO CHANCE he didn’t have a concussion.

The only reason he came back in is because Vince Young threw in INT.

“Dirt in my Eye” if he doesn’t stop playing the way he does, his brain will look like dirt.

Vick is getting $100 Million dollars! Are you freakin’ kidding me?! These guys are being paid to put themselves at risk. I said it. Play. You have to be a different beast to play and love football- you must love contact- getting hit, hitting someone… It’s not soccer, its not track, its not basketball, its not accounting, its not being a doctor, a lawyer or any other profession… its football- you are a gladiator- you fight and battle for glory and you welcome the hits because that is the path to glory. Stop this whining and moaning. If you accept a $100 Million Dollars then you accept the risk of concussions, broken bones, etc- otherwise find a different profession- get a college degree and work like a shmuck the rest of your life like the rest of us.

hittfamily says:Oct 20, 2011 1:05 AM

I have often wondered why football players return so soon from concussions, and baseball players don’t. I am not a doctor, but, having a bruised brain, and returning to a full contact sport a week later seems really soon. Justin Morneau, David Wright and Denard Span had concussions in baseball, and missed entire seasons. Did they pass doctors tests, but couldn’t regain the extreme hand-eye coordination required in baseball, but not football.

It is just a question posed, but perhaps team docs have far more power than they should, and when possible neurological problems may occur, an outside perspective is the way to go. Isolate docs from coaches, make them independednt contractors, and see if there is a difference. Team doctors may not be willing to take as many chances if they aren’t on a long term contract.

Well said! In addition there should be a provision in the CBA that allows, for league paid. independent second opinions for “exit physicals ” both at the end of the season AND when the team cut a player. Teams have been playing this “game” for too long.

“This whole “player safety” thing is a sham. If the NFL truly wanted players to be safe, then players would be wearing flags around their waists.”

“Vick is getting $100 Million dollars! Are you freakin’ kidding me?! These guys are being paid to put themselves at risk. I said it. Play. You have to be a different beast to play and love football- you must love contact- getting hit, hitting someone… It’s not soccer, its not track, its not basketball, its not accounting, its not being a doctor, a lawyer or any other profession… its football- you are a gladiator- you fight and battle for glory and you welcome the hits because that is the path to glory.”

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I think both of these comments sum it up perfectly – make sure the players understand the risks by all means, but football is popular because of the contact.

pjhurley5 says:Oct 20, 2011 9:14 AM

So when this story was first posted (following the games) I made a comment about the only way that the NFL could be sure that this was not happening would be to have independent NFL doctors on the sidelines at games. My comment was (inexplicably, considering I didn’t use any bad language or exhibit any other inappropriate behavior) removed. A few days later PFT posts this story about…independent NFL doctors on the sidelines at games and how that’s what needs to happen. I post a comment on this story stating that I had already made a comment suggesting this that was deleted and….drumroll please….the comment gets deleted within half an hour.

I’m sorry but this is just shady and the way my comments have been deleted just screams corrupt journalism…I never thought I’d say that about this site, but this situation is ridiculous.

While we’re at it, can you leave Best out of it, too? there was no “defining moment” that anyone can point to and say, “see? that’s where best got a concussion, on that play.” he didn’t act like he had a concussion at any point during the game! after the game was over, he started experiencing “concussion-like symptoms”. if the lions were trying to game the system, why report that he had this after the game? it will mean he will have to pass tests (from those independant nuerologists you were mentioning) to get into next weeks game??!! further, the lions’ starting strongside linebacker has missed three weeks, with a concussion! their #2 tight end was out last week, with a concussion! if the team is cheating, why are they reporting concussions and holding players out? your discretionary use of all the facts is sickening, and you are so far up on your high-horse that you will pick and choose anything that makes your “case” and ignore the truth. what happened to profootballtalk being pro. football. talk. ?

nesuperfan says:Oct 20, 2011 9:40 AM

This is the author’s pet cause…I am pretty sure that he wants any rule covering it named after himself.